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Review Myers Cocktail

Intravenous Nutrient Therapy:


the Myers Cocktail
Alan R. Gaby, MD

Abstract It was not clear exactly what the Myers


Building on the work of the late John Myers, cocktail consisted of, as the information provided
MD, the author has used an intravenous by patients was incomplete and no published or
vitamin-and-mineral formula for the treatment written material on the treatment was available. It
of a wide range of clinical conditions. The appeared that Myers used a 10-mL syringe and
modified Myers cocktail, which consists of administered by slow IV push a combination of
magnesium, calcium, B vitamins, and vitamin magnesium chloride, calcium gluconate, thiamine,
C, has been found to be effective against acute vitamin B6, vitamin B12, calcium pantothenate,
asthma attacks, migraines, fatigue (including vitamin B complex, vitamin C, and dilute hydro-
chronic fatigue syndrome), fibromyalgia, acute chloric acid. The exact doses of individual com-
muscle spasm, upper respiratory tract ponents were unknown, but Myers apparently used
infections, chronic sinusitis, seasonal allergic a two-percent solution of magnesium chloride,
rhinitis, cardiovascular disease, and other rather than the more widely available preparations
disorders. This paper presents a rationale for containing 20-percent magnesium chloride or 50-
the therapeutic use of intravenous nutrients, percent magnesium sulfate.
reviews the relevant published clinical The author took over the care of Myers
research, describes the authors clinical patients, using a modified version of his IV regi-
experiences, and discusses potential side men. Most notably, the magnesium dose was in-
effects and precautions. creased by approximately 10-fold by using 20-
(Altern Med Rev 2002;7(5):389-403) percent magnesium chloride, in order to approxi-
mate the doses reported to be safe and effective
Introduction for the treatment of cardiovascular disease.1, 2 In
John Myers, MD, a physician from Balti- addition, the hydrochloric acid was eliminated and
more, Maryland, pioneered the use of intravenous the vitamin C was increased, particularly for prob-
(IV) vitamins and minerals as part of the overall lems related to allergy or infection. Folic acid was
treatment of various medical problems. The au- not included, as it tends to form a precipitate when
thor never met Dr. Myers, despite living in Balti- mixed with other nutrients.
more, but had heard of his work, and had occa- This treatment was suggested for other
sionally used IV nutrients to treat fatigue or acute patients, and it soon became apparent that the
infections. modified Myers cocktail (hereafter referred to as
After Dr. Myers died in 1984, a number the Myers) was helpful for a wide range of clini-
of his patients sought nutrient injections from the cal conditions, often producing dramatic results.
author. Some of them had been receiving injec- Over an 11-year period, approximately 15,000
tions monthly, weekly, or twice weekly for many
years 25 years or more in a few cases. Chronic Alan R. Gaby, MD Past president of the American Holistic
problems such as fatigue, depression, chest pain, Medical Association; author of Preventing and Reversing
Osteoporosis, and co-author of The Patients Book of
or palpitations were well controlled by these treat- Natural Healing.
ments; however, the problems would recur if the Correspondence address: 301 Dorwood Drive, Carlisle,
PA 17013.
patients went too long without an injection.

Alternative Medicine Review Volume 7, Number 5 2002 Page 389


Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Myers Cocktail Review

injections were administered in an outpatient set- Theoretical Basis for IV Nutrient


ting to an estimated 800-1,000 different patients.
Conditions that frequently responded included
Therapy
asthma attacks, acute migraines, fatigue (includ- Intravenous administration of nutrients
ing chronic fatigue syndrome), fibromyalgia, acute can achieve serum concentrations not obtainable
muscle spasm, upper respiratory tract infections, with oral, or even intramuscular (IM), adminis-
chronic sinusitis, and seasonal allergic rhinitis. A tration. For example, as the oral dose of vitamin
small number of patients with congestive heart C is increased progressively, the serum concen-
failure, angina, chronic urticaria, hyperthyroidism, tration of ascorbate tends to approach an upper
dysmenorrhea, or other conditions were also limit, as a result of both saturation of gastrointes-
treated with the Myers and most showed marked tinal absorption and a sharp increase in renal clear-
improvement. Many relatively healthy patients ance of the vitamin.3 When the daily intake of vi-
chose to receive periodic injections because it en- tamin C is increased 12-fold, from 200 mg/day to
hanced their overall well being for periods of a 2,500 mg/day, the plasma concentration increases
week to several months. by only 25 percent, from 1.2 to 1.5 mg/dL. The
During the past 16 years these clinical highest serum vitamin C level reported after oral
results have been presented at more than 20 medi- administration of pharmacological doses of the
cal conferences to several thousand physicians. vitamin is 9.3 mg/dL. In contrast, IV administra-
Today, many doctors (probably more than 1,000 tion of 50 g/day of vitamin C resulted in a mean
in the United States) use the Myers. Some have peak plasma level of 80 mg/dL.4 Similarly, oral
made further modifications according to their own supplementation with magnesium results in little
preferences. In querying audiences from the lec- or no change in serum magnesium concentrations,
tern and from informal discussions with colleagues whereas IV administration can double or triple the
at conferences, the author has yet to encounter a serum levels,5,6 at least for a short period of time.
practitioner whose experience with this treatment Various nutrients have been shown to ex-
has differed significantly from his own. ert pharmacological effects, which are in many
Despite the many positive anecdotal re- cases dependent on the concentration of the nutri-
ports, there is only a small amount of published ent. For example, an antiviral effect of vitamin C
research supporting the use of this treatment. There has been demonstrated at a concentration of 10-
is one uncontrolled trial in which the Myers was 15 mg/dL,4 a level achievable with IV but not oral
beneficial in the treatment of musculoskeletal pain therapy. At a concentration of 88 mg/dL in vitro,
syndromes, including fibromyalgia. Intravenous vitamin C destroyed 72 percent of the histamine
magnesium alone has been reported, mainly in present in the medium.7 Lower concentrations
open trials, to be effective against angina, acute were not tested, but it is possible the serum levels
migraines, cluster headaches, depression, and of vitamin C attainable by giving several grams
chronic pain. In recent years, double-blind trials in an IV push would produce an antihistamine ef-
have shown IV magnesium can rapidly abort acute fect in vivo. Such an effect would have implica-
asthma attacks. There are also several published tions for the treatment of various allergic condi-
case reports in which IV calcium provided rapid tions. Magnesium ions promote relaxation of both
relief from asthma or anaphylactic reactions. vascular8 and bronchial9 smooth muscle effects
This paper presents a rationale for the use that might be useful in the acute treatment of va-
of IV nutrient therapy, reviews the relevant pub- sospastic angina and bronchial asthma, respec-
lished clinical research, describes personal clini- tively. It is likely these and other nutrients exert
cal experiences using the Myers, and discusses additional, as yet unidentified, pharmacological
potential side effects and precautions. effects when present in high concentrations.

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Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Review Myers Cocktail

In addition to having direct pharmacologi- the interval between treatments can be gradually
cal effects, IV nutrient therapy may be more ef- increased, and eventually the injections are no
fective than oral or IM treatment for correcting longer necessary.
intracellular nutrient deficits. Some nutrients are Other patients require regular injections
present at much higher concentrations in the cells for an indefinite period of time in order to control
than in the serum. For example, the average mag- their medical problems. This dependence on IV
nesium concentration in myocardial cells is 10 injections could conceivably result from any of
times higher than the extracellular concentration. the following: (1) a genetically determined impair-
This ratio is maintained in healthy cells by an ac- ment in the capacity to maintain normal intracel-
tive-transport system that continually pumps mag- lular nutrient concentrations;11 (2) an inborn error
nesium ions into cells against the concentration of metabolism that can be controlled only by main-
gradient. In certain disease states, the capacity of taining a higher than normal concentration of a
membrane pumps to maintain normal concentra- particular nutrient; or (3) a renal leak of a nutri-
tion gradients may be compromised. In one study, ent.12 In some cases, continued IV therapy may be
the mean myocardial magnesium concentration necessary because a disease state is too advanced
was 65-percent lower in patients with cardiomy- to be reversible.
10
opathy than in healthy controls, implying a re-
duction in the intracellular-to-extracellular ratio The Modified Myers Cocktail
to less than 4-to-1. As magnesium plays a key role See Table 1 for the nutrients that make up
in mitochondrial energy production, intracellular the modified Myers cocktail.
magnesium deficiency may exacerbate heart fail- Dexpanthenol is the commercially avail-
ure and lead to a vicious cycle of further intracel- able injectable form of pantothenic acid (vitamin
lular magnesium loss and more severe heart fail- B5). One milliliter of B complex 100 contains 100
ure. mg each of thiamine and niacinamide, and 2 mg
Intravenous administration of magnesium, each of riboflavin, dexpanthenol, and pyridoxine.
by producing a marked,
though transient, increase
in the serum concen-
tration, provides a
window of opportunity for Table 1. Nutrients in Myers Cocktail
ailing cells to take up
magnesium against a
smaller concentration Magnesium chloride hexahydrate 20% (magnesium) 2-5 mL
gradient. Nutrients taken
up by cells after an IV Calcium gluconate 10% (calcium) 1-3 mL
infusion may eventually
leak out again, but perhaps Hydroxocobalamin 1,000 mcg/mL (B12) 1 mL
some healing takes place
before they do. If cells are Pyridoxine hydrochloride 100 mg/mL (B6) 1 mL
repeatedly flooded with
nutrients, the improve- Dexpanthenol 250 mg/mL (B5) 1 mL
ment may be cumulative.
B complex 100 (B complex) 1 mL
It has been the authors
observation that some Vitamin C 222 mg/mL (C) 4-20 mL
patients who receive a
series of IV injections
become progressively
healthier. In these patients,

Alternative Medicine Review Volume 7, Number 5 2002 Page 391


Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Myers Cocktail Review

All ingredients are drawn into one syringe, Over the ensuing eight years and three
and 8-20 mL of sterile water (occasionally more) months, he received a total of 63 IV treatments
is added to reduce the hypertonicity of the solu- for acute exacerbations of asthma. In most in-
tion. After gently mixing by turning the syringe a stances, a single injection resulted in marked im-
few times, the solution is administered slowly, provement or complete relief within two minutes,
usually over a period of 5-15 minutes (depending and the acute symptoms did not recur. Occasion-
on the doses of minerals used and on individual ally, a second injection was needed after a period
tolerance), through a 25G butterfly needle. Occa- of 12 hours to two days, and during one episode
sionally, smaller or larger doses than those listed three treatments were required over a four-day
in Table 1 have been used. Low doses are often period. As the patient grew, the nutrient doses were
given to elderly or frail patients, and to those with gradually increased; by age 10 he was receiving
hypotension. Doses for children are lower than 10 mL vitamin C, 3 mL magnesium, 1.5 mL cal-
those listed, and are reduced roughly in propor- cium, and 1 mL each of B12, B6, B5, and B com-
tion to body weight. The most commonly used plex.
regimen has been 4 mL magnesium, 2 mL cal- The treatment was unsuccessful only
cium, 1 mL each of B12, B6, B5, and B complex, once; on that occasion the patient presented with
6 mL vitamin C, and 8 mL sterile water. generalized urticaria, angioedema, and unusually
The following is a review of conditions severe asthma, after the inadvertent ingestion of
successfully treated with the Myers. The num- an artificial food coloring (FD&C red #40) and
bers of patients treated and proportion that re- other potential allergens. Three separate injections
sponded are, for the most part, estimates. given over a 60-minute period produced transient
improvement each time. However, the symptoms
Asthma returned, and he was taken to the emergency room
Case #1: A five-year-old boy presented and hospitalized.
with a two-year history of asthma. During the pre- Despite that single treatment failure, the
vious 12 months he had suffered 20 asthma at- patient and his parents reported that IV nutrient
tacks severe enough to require a visit to the hospi- therapy worked faster, produced a more sustained
tal emergency department. His symptoms ap- improvement, and caused considerably fewer side
peared to be exacerbated by several foods, and effects than the conventional therapies he had re-
skin tests had been positive for 23 of 26 inhalants ceived previously in the emergency room.
tested. His initial treatment consisted of identifi- The author has treated approximately a
cation and avoidance of allergenic foods, as well dozen asthmatics (mainly adults) with the Myers
as daily oral supplementation with pyridoxine (50 for acute asthma attacks; in most instances, marked
mg), vitamin C (1,000 mg), calcium (200 mg), improvement or complete relief occurred within
magnesium (100 mg), and pantothenic acid (100 minutes. A few patients received maintenance in-
mg), in two divided doses with meals. On this regi- jections once weekly or every other week during
men, he experienced marked improvement, and difficult times and reported the treatments kept
had no asthma attacks requiring medical care un- their asthma under better control.
til nearly 11 months after his initial visit. Intravenous magnesium is now well docu-
At that time the child, now six years old, mented as an effective treatment for acute asthma.
presented for an emergency visit with mild but In one study, 38 patients with an acute exacerba-
persistent wheezing and difficulty breathing. He tion of moderate-to-severe asthma that had failed
was given a slow IV infusion containing 6 mL to respond to conventional beta-agonist therapy
vitamin C, 1.4 mL magnesium, and 0.5 mL each were randomly assigned to receive, in double-blind
of calcium, B12, B6, B5, and B complex. The fashion, IV infusions of either magnesium sulfate
symptoms resolved within two minutes and did (1.2 g over a 20-minute period) or placebo (sa-
not recur. line).13 Peak expiratory flow rate improved to a

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Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Review Myers Cocktail

significantly greater extent in the magnesium Calcium is the only other component of
group (225 to 297 L/min) than the placebo group the Myers that has been studied as a treatment
(208 to 216 L/min). In addition, the hospitaliza- for acute exacerbations of asthma. In an early re-
tion rate was significantly lower in the magnesium port, a series of IV infusions of calcium chloride
group than in the placebo group (37% vs. 79%; p relieved asthma symptoms in three consecutive
< 0.01). No patient had a significant drop in blood patients, with relief occurring almost immediately
pressure or change in heart rate after receiving after some injections.20 Intravenous and IM ad-
magnesium. ministration of an unspecified calcium salt tem-
In a second double-blind study, 149 pa- porarily inhibited severe anaphylactic reactions in
tients with acute asthma who were being treated two other patients.21
with inhaled beta-agonists and IV steroids were Nutrients other than magnesium and cal-
randomly assigned to receive an IV infusion of cium may have contributed to the beneficial ef-
magnesium sulfate (2 g over 20 minutes) or sa- fect observed in asthma patients. Oral vitamins
line placebo, beginning 30 minutes after presen- C22 and B623,24 and IM vitamin B1225 have each
tation.14 Among patients with severe asthma (de- been used with some success against asthma, al-
fined as forced expiratory volume in 1 second though none of these nutrients has been tested as
[FEV1] less than 25 percent of predicted value) a treatment for acute attacks. Intramuscular ad-
compared with placebo, magnesium significantly ministration of niacinamide has been shown to
reduced the hospitalization rate (33.3% vs. 78.6%; reduce the severity of experimentally induced
p < 0.01) and significantly improved FEV1. How- asthma in guinea pigs,26 and pantothenic acid ap-
ever, magnesium treatment was of no benefit to pears to have an anti-allergy effect in humans.27
patients with moderate asthma (defined as baseline On one occasion, a patients asthma at-
FEV1 between 25 and 75 percent of predicted tack was treated with IV magnesium alone. Al-
value). though the symptoms resolved rapidly, they re-
In two placebo-controlled studies of asth- turned within 10-15 minutes. The remaining con-
matic children, IV magnesium sulfate significantly stituents of the Myers (without additional mag-
improved pulmonary function and significantly nesium) were then administered, and the symp-
reduced hospitalization rates during acute exacer- toms disappeared almost immediately and did not
bations that had failed to respond to conventional return. Thus, it seems the Myers is more effec-
therapy.15,16 A dose of 40 mg per kg body weight tive than magnesium alone in the treatment of
(maximum dose, 2 g) given over a 20-minute pe- asthma attacks.
riod appeared to be more effective than 25 mg per
kg. Higher doses of IV magnesium sulfate (10-20 Migraine
g over 1 hour, followed by 0.4 g per hour for 24 Case #2: A 44-year-old female suffered
hours) have been used successfully in the treat- from frequent migraines, which appeared to be
ment of life-threatening status asthmaticus.6 In a triggered in many instances by exposure to
few studies, IV magnesium failed to improve pul- environmental chemicals or, occasionally, to
monary function or to reduce the need for hospi- ingestion of foods to which she was allergic.
talization.17,18 However, a meta-analysis of seven Allergy desensitization therapy had provided little
randomized trials concluded that IV magnesium benefit. Over a six-year period, the patient was
reduced the need for hospitalization by 90 per- given IV therapy on approximately 70 occasions
cent among patients with severe asthma, although for migraines. Nearly all of these injections
the treatment was not beneficial for patients with resulted in considerable improvement or complete
moderate asthma.19 relief within several minutes, although a few
treatments were ineffective. Through trial and
error, it was determined her most effective regimen

Alternative Medicine Review Volume 7, Number 5 2002 Page 393


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Myers Cocktail Review

was 16 mL vitamin C, 5 mL magnesium, 4 mL Fatigue


calcium, 2 mL B6, and 1 mL each of B12, B5, and Many patients with unexplained fatigue
B complex. The 4-mL dose of calcium was found have responded to the Myers, with results lasting
to provide better relief than lower calcium doses. only a few days or as long as several months. Pa-
Over the years, a half dozen other patients tients who benefited often returned at their own
have presented one or more times with an acute discretion for another treatment when the effect
migraine. In almost every instance, the Myers had worn off. One patient with fatigue associated
produced a gratifying response within a few min- with chronic hepatitis B experienced marked and
utes. progressive improvement in energy levels with
The beneficial effect of IV magnesium as weekly or twice-monthly injections.
a treatment for migraine has been demonstrated Approximately 10 patients with chronic
in recent clinical trials. In one study, 40 patients fatigue syndrome (CFS) received a minimum of
with an acute migraine received 1 g magnesium four treatments (usually once weekly for four
sulfate over a five-minute period.28 Fifteen min- weeks), with more than half showing clear im-
utes after the infusion, 35 patients (87.5%) re- provement. One patient experienced dramatic ben-
ported at least a 50-percent reduction of pain, and efit after the first injection, whereas in other cases
nine patients (22.5%) experienced complete re- three or four injections were given before improve-
lief. In 21 of 35 patients who benefited, the im- ment was evident. A few patients became progres-
provement persisted for 24 hours or more. Patients sively healthier with continued injections and were
with an initially low serum ionized magnesium eventually able to stop treatment. Several others
concentration (less than 0.54 mMol/L) were sig- did not overcome their illness, but periodic injec-
nificantly more likely to experience long-lasting tions helped them function better.
improvement than were patients with initially There is some research support for the use
higher serum ionized magnesium levels. In a of parenteral magnesium in patients with fatigue.
single-blind trial that included 30 patients with an One study found magnesium deficiency, demon-
acute migraine, IV administration of magnesium strated by an IV magnesium-load test, in 47 per-
sulfate (1 g over 15 minutes) completely and per- cent of 93 patients with unexplained chronic fa-
manently relieved pain in 13 of 15 patients tigue, including 50 with CFS.31 In a second study,
(86.6%), whereas no patients in the placebo group the mean erythrocyte magnesium concentration
became pain free (p < 0.001 for difference between was significantly lower in 20 patients with CFS
groups).29 In addition, magnesium treatment re- than in healthy controls.32
sulted in rapid disappearance of nausea, vomit- As one arm of the second study, 32 pa-
ing, and photophobia in all 14 patients who had tients with CFS were randomly assigned to re-
experienced those symptoms. ceive, in double-blind fashion, 1 g magnesium
A single 1-g dose of magnesium sulfate sulfate IM or placebo, once weekly for six weeks.
has also been reported to abort an episode of clus- Twelve (80%) of 15 patients given magnesium
ter headaches in seven of 22 patients (32%), and a reported improvement (e.g., more energy, a better
series of three to five injections provided sustained emotional state, and less pain) and fatigue was
relief in an additional two patients (9%).30 eliminated completely in seven cases. In contrast,
It is not clear whether the Myers is more only three (18%) of 17 placebo-treated patients
effective than magnesium alone for migraines; improved (p = 0.0015 for difference between
however, one patient did experience noticeable groups), and in no case was the fatigue completely
benefit from IV calcium. eliminated. According to one report, at least half
of CFS patients with magnesium deficiency ben-
efited from oral magnesium supplementation;
however, some patients needed IM injections.33

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Review Myers Cocktail

Other investigators, using the IV magnesium-load month between treatments. However, they were
test, found no evidence of magnesium deficiency never as severe as they were before she began re-
in patients with CFS, and observed no improve- ceiving IV therapy.
ment in symptoms following a single infusion of The author has given the Myers to ap-
magnesium sulfate (6 g in one hour).34 proximately 30 patients with fibromyalgia; half
Vitamin B12, given IM, has been reported have experienced significant improvement, in a
to be helpful for patients with unexplained fa- few cases after the first injection, but more often
tigue,35 as well as those with CFS.36 While the re- after three or four treatments.
sults obtained with the Myers may be attribut- The beneficial effect of parenteral nutri-
able in part to vitamin B12, many patients who ent therapy has been confirmed by one study pub-
responded to IV therapy obtained little or no ben- lished only as an abstract. Eighty-six patients with
efit from IM vitamin B12 alone. chronic muscular complaints, including
myofascial pain, relapsing soft tissue injuries, and
Fibromyalgia fibromyalgia, received IM or IV injections of
Case #3: A 48-year-old woman presented magnesium, either alone or in combination with
with a six-year history of fairly constant myalgias calcium, B vitamins, and vitamin C.37 Improve-
and arthralgias, with pain in the neck, back, and ment occurred in 74 percent of the patients; of
hip, and tightness in the left arm. Six months pre- those, 64 percent required four or fewer injections
viously she was found to have an elevated sedi- for optimal results. A minority of patients required
mentation rate (50 mm/hr). She was diagnosed by long-term oral or parenteral magnesium to main-
a rheumatologist as possibly having polymyalgia tain improvement. The positive response to
rheumatica, although the diagnosis of fibromyalgia parenteral magnesium is consistent with the ob-
was also considered. Her history was also signifi- servation that nearly half of patients with
cant for migraines about eight times per year and fibromyalgia have intracellular magnesium defi-
chronic nasal congestion. Physical examination ciency, despite having normal serum levels of the
revealed extremely stiff muscles, with decreased mineral.38
range of motion in many areas of her body.
The patient was given a therapeutic trial Depression
consisting of 6 mL vitamin C, 4 mL magnesium, Case #4: A 46-year-old man presented
2.5 mL calcium, and 1 mL each of B12, B6, B5, with a history of depression and anxiety since
and B complex. At the end of the injection, she childhood. He had been in psychoanalysis for the
got off the table and, with a look of amazement, past eight years. A therapeutic trial with IV nutri-
announced her muscle aches and joint pains were ents was considered because the patient reported
gone for the first time in six years. This treatment that consumption of alcohol (known to deplete
was repeated after a week (at which time her symp- magnesium) aggravated his symptoms, and be-
toms had not returned), followed by every other cause he was taking a magnesium-depleting thi-
week for several months, then once monthly for azide diuretic for hypertension. He was initially
three years. Her initial regimen also included the given 1 mL each of magnesium, B12, B6, B5, and
identification and avoidance of allergenic foods B complex, which resulted in a 70-80 percent re-
and treatment with low-dose desiccated thyroid duction in his symptoms for one week. A second
(eventually stabilized at 60 mg per day). She dis- injection produced a similar response that lasted
covered that eating refined sugar caused myalgias two weeks. Through trial and error it was deter-
and arthralgias, and that thyroid hormone im- mined the most effective treatment was 5 mL
proved her energy level, mood, and overall well magnesium, 3 mL B complex, and 1 mL each of
being. During the three years of monthly mainte- B12, B6, and B5. The addition of calcium to the
nance injections she reported symptoms would injection appeared to block some of the benefit.
begin to recur if she went much longer than a

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Myers Cocktail Review

Both oral and IM administration of the same nu- patient that his heart would not last more than
trients were tried but found to be ineffective. another month, so the patient declined the ampu-
Weekly injections provided almost complete re- tations.
lief from symptoms and allowed him to discon- He was treated with weekly IM injections
tinue psychotherapy. The patient noted that rap- of magnesium sulfate (1 g) for eight weeks, and
idly administered injections provided longer-last- prescribed oral supplementation with vitamins C
ing relief than did slower injections. The infusion and E, B complex, folic acid, and zinc. The mag-
rate was therefore carefully and progressively in- nesium injections appeared to reduce the pain in
creased, without causing any adverse side effects his gangrenous toes considerably, with the ben-
or changes in blood pressure or heart rate. The efit lasting about five days each time. Six weeks
patient reported that when the treatment was given after the first injection, his ejection fraction had
over a one-minute period, the effect would last increased from 19 percent to 36 percent and he no
approximately two weeks, whereas a slower in- longer required supplemental oxygen. After eight
jection (such as five minutes) would last only a weeks, the IM injections were replaced by weekly
week. Approximately four years after initial treat- IV injections, consisting of 5 mL magnesium, 1
ment, he was able to reduce the frequency of in- mL each of B12, B6, B5, and B complex, and a
jections to once monthly or less. low-dose (0.2 mL) trace mineral preparation
Many other patients with depression and/ (MTE-5 containing: zinc, copper, chromium, se-
or anxiety have shown a positive response to the lenium, and manganese). After a total of 18
Myers. However, this treatment should not be months, his weight had increased from 113 to 147
considered first-line therapy for major depression. pounds, which was remarkable as cardiac cachexia
It seems to be helpful only for certain subsets of is generally considered to be irreversible. In addi-
depressed individuals, such as those who also suf- tion, the gangrenous areas on his toes had sloughed
fer from fibromyalgia, migraines, excessive stress, and been replaced almost entirely by healthy tis-
or alcohol-induced exacerbations. Shealy et al sue. Intravenous therapy was continued and even-
have observed an antidepressant effect of IV mag- tually reduced to every other week. The patient
nesium in some patients with chronic pain.39 lived for eight years and died at age 87 from mul-
tiple organ failure.
Cardiovascular Disease Of the handful of other patients with an-
Case #5: A 79-year-old man was seen at gina or heart failure who received IV or IM injec-
home in end-stage heart failure, after having suf- tions of magnesium (with or without B vitamins),
fered four myocardial infarctions. During the pre- all showed significant improvement. The results
vious 12 months, spent mostly in the hospital, he with angina are consistent with those reported by
had become progressively worse; his ejection frac- others using parenteral magnesium therapy.40-42
tion had fallen to 19 percent and his body weight
had declined from 171 pounds to a severely Upper Respiratory Tract Infections
cachectic 113 pounds. He was confined to bed and Case #6: A 40-year-old male presented
required supplemental oxygen much of the time. with a cold and a one-day history of fatigue, nasal
He also had severe peripheral occlusive arterial congestion, and rhinorrhea. He was given an IV
disease, which had resulted in the development of infusion of 16 mL vitamin C, 3 mL magnesium,
gangrene of six toes. A peripheral angiogram re- 1.5 mL calcium, and 1 mL each of B12, B6, B5,
vealed complete occlusion of both femoral- and B complex. By the end of the 10-minute treat-
popliteal arteries, with no detectable blood flow ment he was symptom free. The cold symptoms
to the distal extremities. Two independent vascu- did return the next day but were only 10 percent
lar surgeons had recommended bilateral above- as severe as before the injection.
the-knee amputations to prevent development of
septicemia. However, the cardiologist advised the

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Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Review Myers Cocktail

One-quarter to one-third of patients who


received the Myers for an acute respiratory in- Narcotic Withdrawal
fection experienced marked improvement, either Case #9: A 35-year-old man addicted to
immediately or by the next morning. Approxi- morphine came to the office in the early stages of
mately half of patients given this treatment re- withdrawal, with diaphoresis and extreme agita-
ported that it shortened the duration of their ill- tion. He was given an IV infusion of 16 mL vita-
ness. Patients who benefited tended to have a simi- min C, 5 mL magnesium, 2.5 mL calcium, and 1
lar response if treated for a subsequent infection, mL each of B12, B6, B5, and B complex. In his
whereas non-responders tended to remain non-re- agitated state he was unable to sit still on the exam
sponders. table, so we walked up and down the hall with a
Case #7: A 32-year-old female had a long butterfly needle in his arm. Halfway through the
history of chronic sinusitis. Avoidance of aller- injection, he was able to sit still, and by the end of
genic foods and oral supplementation with vita- the injection his withdrawal symptoms were alle-
min C and other nutrients had provided only mini- viated. The symptoms returned 36 hours later; he
mal benefit. She was given an IV infusion of 20 therefore came for another treatment, which again
mL vitamin C, 4 mL magnesium, 2 mL calcium, relieved the symptoms within minutes. He re-
and 1 mL each of B12, B6, B5, and B complex; turned the next day, still symptom free, for a third
this protocol was repeated the next day. At the time injection, which carried him uneventfully through
these injections were given she had been experi- the remainder of the withdrawal period.
encing persistent sinus problems for a year. Her
symptoms resolved rapidly after the injections and Chronic Urticaria
she remained relatively symptom free for more Case #10: A 71-year-old woman had
than six months. The same treatment given at a chronic urticaria with hives present somewhere
later date was also helpful, although the benefit on her body nearly every day for 10 years. An al-
was not as pronounced as the first time. lergy-elimination diet and oral supplementation
One other patient with chronic sinusitis with vitamin C and other nutrients provided little
had a similar response to back-to-back injections, or no relief. She was given an IV infusion of 12
while a few others showed no improvement. mL vitamin C, 3 mL magnesium, 1.5 mL calcium,
and 1 mL each of B12, B6, B5, and B complex.
Seasonal Allergic Rhinitis The same treatment was repeated the following
Case #8: A 38-year-old man had a long day. After these injections the hives resolved rap-
history of seasonal allergic rhinitis, occurring each idly and did not recur for more than a year. When
spring and lasting about a month. Symptoms in- the lesions did recur, the IV treatment was repeated
cluded nasal congestion, itchy eyes, and fatigue. but was ineffective.
During a symptomatic period, an IV infusion of
12 mL vitamin C, 3 mL magnesium, and 1 mL Athletic Performance
each of B12, B6, B5, and B complex provided Case #11: An 18-year-old, 235-pound
rapid relief. This treatment was repeated as needed high school wrestler developed a flu-like illness
during the hay fever season (once weekly or less) four days before a major tournament. Two days
and successfully controlled his symptoms. In sub- before the three-day tournament, when it appeared
sequent years he began the IVs shortly before, and he might have to miss the event, he was given an
repeated them periodically during, the hay fever IV injection of 16 mL vitamin C, 5 mL magne-
season; this approach prevented the development sium, 2.5 mL calcium, and 1 mL each of B12, B6,
of symptoms. B5, and B complex. The next morning he remarked
that he had more energy than he had ever had in

Alternative Medicine Review Volume 7, Number 5 2002 Page 397


Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Myers Cocktail Review

his life. This energy boost persisted for the dura- treatments. Of three patients with acute dysmen-
tion of the tournament, at which he took second orrhea treated with the Myers, two experienced
place, a better performance than at any other time almost instant pain relief. One patient with chronic
in his career. obstructive pulmonary disease intermittently re-
In this era in which many athletes are us- ceived weekly IV injections and reported the treat-
ing performance-enhancing drugs, it is not the ments improved his strength and breathing.
authors intention to encourage athletes to seek
another boost with IV nutrients. However, this Choice of Ingredients and
case does demonstrate that nutritional factors can
play an important role in athletic performance.
Administration
At the time of this writing, cyanocobalamin
is a widely available form of injectable vitamin B12,
Hyperthyroidism whereas hydroxocobalamin can be obtained only
Two patients with hyperthyroidism were through a compounding pharmacist. While both
treated with the Myers once or twice weekly for forms of the vitamin are effective, hydroxocobal-
several weeks. In one case, the treatment con- amin is preferred because it produces more pro-
trolled the symptoms of hyperthyroidism, although longed increases in serum vitamin B12 levels.48
there was no reduction in thyroid-hormone lev- It has been the authors impression (and
els. The injections were discontinued after medi- that of other clinicians) that some patients who re-
cal therapy had restored the hormone levels to spond to IM vitamin B12 injections do not experi-
normal. In the other case, symptoms improved ence the same benefit when vitamin B12 is given
markedly after the first injection and thyroid-func- as part of the Myers. It is possible that vitamin C
tion tests, measured two weeks later, returned to or another component of the Myers destroys some
normal. of the vitamin B12,49 or that IV vitamin B12 is lost
The potential value of IV nutrient therapy more rapidly in the urine than IM vitamin B12.
for patients with hyperthyroidism is supported by Therefore, for some patients receiving IV nutrient
several studies. Serum and erythrocyte magnesium therapy, the vitamin B12 is given IM in a separate
levels have been found to be low in patients with syringe.
Graves disease.43 In addition, daily IM injections Injectable magnesium can be obtained
of magnesium chloride (20 mL of a 14-percent either as magnesium chloride hexahydrate (20%
solution) for 3-7 weeks reduced the size of the solution), commonly called magnesium chloride,
thyroid gland and improved the clinical condition or magnesium sulfate heptahydrate (50% solution),
of three patients with hyperthyroidism.44 Intrave- commonly called magnesium sulfate. Although
nous vitamin B6 (50 mg per day) was reported to most clinical research has been done with
relieve muscle weakness in three patients with magnesium sulfate, some experts prefer magnesium
hyperthyroidism,45 and animal studies indicate chloride for IV use because of its greater retention
vitamin B12 can counteract some of the adverse in the body.50 The author has used magnesium
effects of experimentally induced hyperthyroid- chloride almost exclusively for IV therapy, while
ism.46,47 reserving the more concentrated magnesium sulfate
for IM administration. For those using magnesium
Other Conditions sulfate, it should be noted that 1 g (2 mL of a 50-
The modified Myers cocktail seems to percent solution) is equivalent to 0.8 g (4 mL of a
provide rapid relief for patients with acute muscle 20-percent solution) of magnesium chloride (each
spasm resulting from sleeping in the wrong posi- contains 4 mMol of magnesium). In addition, if 50-
tion or from overuse. It also has been observed to percent magnesium sulfate is given IV instead of
relieve tension headaches in many cases. One pa- 20-percent magnesium chloride, it should be diluted
tient (a 70-year-old female) with chronic torticol- appropriately with sterile water.
lis experienced moderate pain relief with periodic

Page 398 Alternative Medicine Review Volume 7, Number 5 2002


Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Review Myers Cocktail

Injectable vitamin C is currently available temporarily and not resumed until the symptoms
in concentrations of 222 and 500 mg per mL. The have resolved (usually after 10-30 seconds). Pa-
author typically uses the lower concentration for tients with low blood pressure tend to tolerate less
IV therapy. If the higher concentration is used, it magnesium than do patients with normal blood
should be diluted appropriately with sterile water. pressure or hypertension. In a small proportion of
Occasionally, trace minerals were included patients, even a low-dose regimen given very
as part of a nutrient infusion. The usual dose was slowly causes persistent hypotension; in those
0.2-0.5 mL of MTE-5, which contains (per mL): cases, the treatment is usually discontinued and
zinc 1 mg, copper 0.4 mg, chromium 4 mcg, sele- may or may not be attempted at a later date.
nium 20 mcg, and manganese 0.1 mg. The prepa- Although too rapid administration can
ration was diluted six-fold and administered over a have adverse consequences, some patients appear
period of 1-2 minutes in a separate syringe at the to experience more pronounced benefits from
end of the Myers push. Two adverse reactions have rapid infusions than from slower ones, presum-
been noted with 10 mg of zinc given by slow IV ably because of higher peak serum concentrations
push; consequently, when giving trace minerals by of nutrients. While both the risks and benefits
IV push, very small doses are used. Trace minerals should be taken into account in determining an
should not be mixed in the same syringe with the infusion rate, when in doubt one should err on the
components of the Myers, as doing so often causes side of safety. When administering the Myers to
formation of a precipitate. a patient for the first time, it is best to give 0.5-1.0
mL and then wait 30 seconds or so before pro-
Side Effects and Precautions ceeding with the rest of the infusion. Doing so may
The Myers often produces a sensation of help one distinguish between a vasovagal reac-
heat, particularly with large doses or rapid admin- tion and a hypotensive response to the injected
istration. This effect appears to be due primarily compounds. Patients who experience a vasovagal
to the magnesium, although rapid injections of reaction at the beginning of an infusion can usu-
calcium have been reported to produce a similar ally tolerate the remainder of the treatment after
effect.22 The sensation typically begins in the chest the reaction has worn off.
and migrates to the vaginal area in women and to For elderly or frail individuals, it may be
the rectal area in men. For most patients the heat advisable to start with lower doses than those listed
does not cause excessive discomfort; indeed, some in Table 1, or to consider IM administration of
patients enjoy it. However, if the infusion is given magnesium and B vitamins as an alternative to IV
too rapidly, the warmth can be overbearing. Some therapy. However, many elderly patients have tol-
women experience a sensation of sexual pleasure erated, and benefited from, IV therapy.
in association with the vaginal warmth; on rare Patients who are deficient in both mag-
occasions, an orgasm may occur during an IV in- nesium and potassium may have an influx of po-
fusion. Other patients have remarked their visual tassium into the cells after receiving IV magne-
acuity and color perception become sharper im- sium.51 This occurs because magnesium activates
mediately after an injection, as if someone had the membrane pump that promotes the intracellu-
turned the lights on. In some cases, this effect lasts lar uptake of potassium. The shift of potassium
as long as one or two days. from the serum to the intracellular space can trig-
Too rapid administration of magnesium ger hypokalemia. The author has seen two patients
can cause hypotension, which can lead to develop severe muscle cramps several hours after
lightheadedness or even syncope. Patients receiv- receiving a Myers; both patients had been taking
ing a Myers should be advised to report the onset medications known to deplete potassium. Hy-
of excessive heat (which can be a harbinger of pokalemia also increases the risk of digoxin-in-
hypotension) or lightheadedness. If either of these duced cardiac arrhythmias. As a first-year resident,
symptoms occurs, the infusion should be stopped

Alternative Medicine Review Volume 7, Number 5 2002 Page 399


Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Myers Cocktail Review

unaware of this potential problem, the author ad- reactions for every million ampules of IV B vita-
ministered IV magnesium in the hospital to an eld- mins sold, and one report for every 5 million IM
erly woman who was taking digoxin and a potas- ampules sold.53
sium-depleting diuretic. She quickly developed an It is possible the risk of anaphylaxis from
arrhythmia, which required short-term treatment in the Myers is even lower than the low risk associ-
the intensive care unit. ated with the use of IV thiamine. Many patients
Patients considered to be at risk of potas- who receive parenteral thiamine are alcoholics, and
sium deficiency include those taking potassium- alcoholism frequently causes magnesium defi-
depleting diuretics, beta-agonists, or glucocorti- ciency. Animal studies suggest thiamine supple-
coids; those with diarrhea or vomiting; and those mentation in the presence of magnesium deficiency
who are generally malnourished. If a patient is hy- increases the severity of the magnesium defi-
pokalemic, the hypokalemia should be corrected ciency.54 A deficiency of magnesium can lead to
before IV magnesium therapy is considered. How- spontaneous release of histamine,55 and has been
ever, a normal serum potassium concentration is reported to increase the incidence of experimen-
not a guarantee against intracellular potassium tally induced anaphylaxis in animals.56 The pres-
depletion. For patients considered to be at risk of ence of magnesium in the Myers might, therefore,
potassium deficiency, administration of 10-20 mEq reduce the risk of an anaphylactic reaction to thia-
of potassium orally just prior to the infusion, and mine. Moreover, as the Myers has been used suc-
again 4-6 hours later is recommended. After this cessfully to treat asthma and urticaria, it is likely
practice was instituted, no further problems with the formula as a whole provides prophylaxis against
magnesium-induced muscle cramps were encoun- anaphylaxis. Nevertheless, practitioners who ad-
tered. minister IV nutrients should be prepared to deal
The addition of even small amounts of with the rare anaphylactic reaction.
potassium to an IV push is strongly discouraged, A small number of patients (approximately
because of the theoretical risk of triggering an ar- one percent) felt out of sorts for up to a day after
rhythmia during the first pass when the bolus receiving an injection and, in two cases, this reac-
reaches the cardiac conducting system. tion lasted one and two weeks, respectively. It is
Intravenous calcium is contraindicated in not clear whether these reactions were due to the
patients taking digoxin. In addition, hypercalcemia preservatives in some of the injectable preparations
can cause cardiac arrhythmias. For that reason, the (e.g., benzyl alcohol, methylparabens, or others)
author has tended to leave calcium out of the Myers or to the nutrients themselves. In most cases (in-
when treating patients with cardiac disease, al- cluding a few patients with asthma) preservative-
though there is no strong evidence it is dangerous containing products were used because the use of
for such patients. multi-dose vials reduced the cost of treatment to
Anaphylactic reactions to IV thiamine have the patient. However, for some individuals with
been reported on rare occasions. Only three such known chemical sensitivities or other significant
reactions have been identified in the U.S. litera- allergy-related problems, preservative-free prepa-
ture since 1946. However, in the world literature, a rations were used.
total of nine deaths attributed to thiamine adminis- Although the Myers is extremely hyper-
tration were reported between 1965 and 1985.52 tonic, it rarely seemed to cause problems related to
These reactions have occurred after oral, IV, IM, its hypertonicity. Two or three patients developed
or subcutaneous administration, and are believed phlebitis at the injection site; for those patients, later
to be due in part to a nonspecific release of hista- treatments were diluted with sterile water to a total
mine. Anaphylactic reactions have been seen most of 60 mL. Some patients experienced a burning
often after multiple administrations of thiamine. In sensation at the injection site during the infusion;
the United Kingdom, between 1970 and 1988, there this was often corrected by re-positioning the needle
were approximately four reports of anaphylactoid or by further diluting the nutrients.

Page 400 Alternative Medicine Review Volume 7, Number 5 2002


Copyright2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Review Myers Cocktail

When administered with caution and re- References


spect, the Myers has been generally well tolerated, 1. Malkiel-Shapiro B. Further observations on
and no serious adverse reactions have been encoun- parenteral magnesium sulfate therapy in
tered with approximately 15,000 treatments. coronary heart disease: a clinical appraisal. S
Afr Med J 1958;32:1211-1215.
Cost Considerations 2. Browne SE. Intravenous magnesium sulphate
in arterial disease. Practitioner 1969;202:562-
In 1995, the authors last year in private 564.
practice, the cost of the materials for a Myers was
3. Blanchard J, Tozer TN, Rowland M. Pharma-
approximately $5.00. The use of preservative-free cokinetic perspectives on megadoses of
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Nursing time and administrative factors repre- 1171.
sented the majority of the cost of IV nutrient 4. Harakeh S, Jariwalla RJ, Pauling L. Suppres-
therapy. In 1995, the authors fee for a Myers was sion of human immunodeficiency virus
$38.00. Other doctors have charged as little as replication by ascorbate in chronically and
acutely infected cells. Proc Natl Acad Sci U S
$15.00 or as much as $100.00 or more. Since 1995,
A 1990;87:7245-7249.
the cost of most of the injectable preparations has
5. Okayama H, Aikawa T, Okayama M, et al.
increased by 50-100 percent. Bronchodilating effect of intravenous magne-
Insurance companies do not generally pay sium sulfate in bronchial asthma. JAMA
for this treatment. However, in a few instances, 1987;257:1076-1078.
showing them that IV nutrient therapy had greatly 6. Sydow M, Crozier TA, Zielmann S, et al.
reduced the overall cost of the patients health care High-dose intravenous magnesium sulfate in
persuaded them to pay. the management of life-threatening status
asthmaticus. Intensive Care Med 1993;19:467-
471.
Conclusion 7. Uchida K, Mitsui M, Kawakishi S.
The Myers has been found by the author Monooxygenation of N-acetylhistamine
and hundreds of other practitioners to be a safe mediated by L-ascorbate. Biochim Biophys
and effective treatment for a wide range of clini- Acta 1989;991:377-379.
cal conditions. In many instances this treatment is 8. Iseri LT, French JH. Magnesium: natures
more effective and better tolerated than conven- physiologic calcium blocker. Am Heart J
1984;108:188-193.
tional medical therapies. Although most of the
evidence is anecdotal, some published research has 9. Brunner EH, Delabroise AM, Haddad ZH.
Effect of parenteral magnesium on pulmonary
demonstrated the efficacy of the Myers or some function, plasma cAMP, and histamine in
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of many individuals. Additional research is ur- antiarrhythmic response to magnesium
gently needed to confirm the effectiveness of this infusion. Lancet 1987;2:1019.
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to renal tubular defect in reabsorption of
trials comparing the Myers with established thera- magnesium. J Pediatr 1974;85:350-354.
pies would be informative. Practitioners using this
13. Skobeloff EM, Spivey WH, McNamara RM,
treatment are encouraged to report their findings. Greenspon L. Intravenous magnesium sulfate
for the treatment of acute asthma in the
emergency department. JAMA 1989;262:1210-
1213.

Alternative Medicine Review Volume 7, Number 5 2002 Page 401


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Myers Cocktail Review

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Review Myers Cocktail

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